While a substantial literature has established links between pregnancy intendedness, variously defined, and child health outcomes, the connection between a woman’s feelings about a current pregnancy and the outcomes of that pregnancy has received little attention. In this issue of Perspectives on Sexual and Reproductive Health, Susan M. Blake and colleagues report on both pregnancy intentions and happiness, and the relative importance of each in predicting risk factors, in a sample of black women attending prenatal clinics in Washington, DC (see article).

One of the most intriguing findings is that level of happiness about a pregnancy was associated with more psychosocial and behavioral risk factors for poor outcomes than were intentions. For example, women who were unhappy about their pregnancy were more likely than those who were happy to report intimate partner violence or recent depression, risk factors that were not associated with intendedness. The analyses also uncover "a distinct pattern of personal and social factors" that were linked to happiness about pregnancy. Ensuring that women are screened for factors that may affect their feelings about a pregnancy, the authors conclude, would be a "critical step in improving both maternal andinfant health."

Also in This Issue

•Women’s ability to control their fertility depends to a great extent on the quality of services they receive, yet in a review of the literature over the last two decades, Davida Becker and coauthors (see article) identi- fied only 29 studies that have reported on the quality of services in the United States. The investigators find that an important strength of the available research is its tendency to approach quality as a multi- dimensional concept; an important weakness, however, is the lack of consistency in the domains of quality that have been studied. Becker and coauthors propose a conceptual framework and suggest areas of study and methodologies that could "strengthen the literature, so that more can be done to improve family planning services."

•Using statistics from 60 countries around the world in which abortion is broadly legal, Gilda Sedgh and colleagues find that the countries in which the abortion rate decreased between 1996 and 2003 outnumbered those in which it increased (see article). Although the sharpest declines occurred in Eastern Europe and Central Asia, rates in those regions remained among the highest in the world—a legacy of the Soviet era, when abortion was freely available but contraceptive options were limited and in short supply. The highest estimated levels were in Armenia, Azerbaijan and Georgia, where surveys indicate that women will have, on average, three abortions during their reproductive lives.

•Women who have no health insurance are 30% less likely than those with any coverage, private or public, to be using prescription contraceptives, Kelly R. Culwell and Joe Feinglass report (see article). Their analyses, based on data from the 2002 Behavioral Risk Factor Surveillance System, reveal that insurance is associated with use of the most effective methods even among subgroups of women who are relatively unlikely to use these methods. Culwell and Feinglass acknowledge that not all women wish to use prescription contraceptives, but they argue that "it is important that all women, regardless of insurance status, have equal access to a wide variety of contraceptive options."

•Overcoming the limitations of earlier studies, which generally have focused only on men or on one ethnic group, Hyeouk Chris Hahm and coauthors have used data from Wave 3 of the National Longitudinal Study of Adolescent Health to study predictors of STDs among a nationally representative sample of Asian and Pacific Islander young adults (see article). They find that women are considerably more likely than men ever to have had an STD, and the disparity exceeds that documented in ethnically diverse samples. They also find that Indian Americans have elevated odds of having had an STD. The findings underscore the importance both of studying the particular needs of the rapidly growing Asian and Pacific Islander population and of recognizing that those needs may differ among subgroups of that population.

•The ways in which positive aspects of sexual experience contribute to women’s sexual and reproductive health are little understood, according to a Comment by Jenny Higgins and Jennifer Hirsch (see article). This "pleasure deficit" affects not only women’s use of condoms, but also their use of other methods. The authors note that few systematic reviews have examined how contraceptive methods affect women’s sexual desire, pleasure, lubrication and ability to achieve orgasm, and further, how such effects shape women’s adoption and continuation of methods and their consistency of use. In sum, they say, researchers and program developers need to work from the assumption that the way sex feels matters to women, and that recognizing and addressing this aspect of women’s lives will positively affect their risk behaviors— and, more broadly, their sexual health and well-being. —The Editors